Is the Internet Harming Your Practice and Patients?

It’s rarely a great thing for a doctor to have a patient walk in with a self made diagnosis. There are two ways the patient came up with that diagnosis. The first explanation would be that the patient is also a doctor. This sounds great theoretically but in reality it sucks. Doctors make the worst patients. They are difficult to treat and will always have their own perspective on their illness. They will want an explanation for almost everything and you’ll feel like your performance is being monitored and judged. In comparison to the alternative of how your patient managed to diagnose himself or herself, them being a doctor won’t seem so bad.

The alternative is that your patient is a non-medical citizen who did what so many people do these days: rely on the internet. They looked up their symptoms online until they reached a diagnosis that seemed plausible to them. Needless to say that these diagnoses are almost always wrong and any online algorithm that says it can diagnose you is a scam. Diagnoses reached through the internet will harm your practice and even worse: they’ll harm your patients. Patients will not only start to challenge your diagnosis because of what they read on the internet, but they may also neglect the treatment you prescribed or keep seeking more doctors looking to hear what they want. They’ll also want to do more investigations in an effort to prove themselves right. The worst result of it all would be self medicating themselves which can have countless consequences.

Let’s face it; almost all of us have googled our symptoms at some point in our lives. Even I used to do it before I got into med school. I remember looking up my headache only to be told by the mighty internet that it’s probably brain cancer. It’s funny how the internet will tell you that it’s usually cancer when it’s probably something that’ll resolve on its own within a few days. That’s the thing about medicine, most conditions are self resolving and don’t even need any sort of intervention. Medical intervention usually ameliorates a patient’s symptoms in order to make them feel better and may hasten recovery. Imagine the panic and frenzy someone will feel if they look up what they have and the online results say it’s something really serious. Imagine looking up diarrhea to be told that you have IBD or stomach pain to be told that it’s cancer. It can cause a person a lot of stress and anxiety that will also spread to their loved ones. This will make them rush to a doctor or hospital and they’ll probably be difficult to deal with. You’ll need to calm them down and reassure them explaining to them why it’s not the terrible disease they saw online and why your diagnosis is correct. It’ll be your medical diagnosis against their online diagnosis and you’re going to have to convince the patient that they’re not dying and that it’s, hopefully, a benign condition.

This brings us to the next problem with online diagnoses: your patients will challenge you. This will be especially true if your patients are highly educated and stubborn. A lot of people don’t like being wrong, it’s how they’ve always been. They will stand by the diagnosis they got online even if it’s worse for them. Patients may also resist what you have to say out of fear. You’re telling them it’s a stress headache but they’re worried about it being a tumor. Of course they would love for it to be a stress headache, but they know that tumors are easier to treat if they’re caught early. So what if you’re wrong and it actually turns out to be a tumor? Can they trust you enough to believe you? Out of fear they may think you’re being incompetent or not thorough enough which, in their head, may eventually cost them their life. As their doctor you’re going to need to be extremely confident and transmit that feeling of confidence to them. They need to believe that you really are an amazing doctor and that you can’t be wrong. That way they’ll listen to you and not doubt your diagnosis.

If you’re incapable of doing that then they’ll continue to doubt you and since there’s nothing to decide and it’s their word against yours (which they don’t really believe in) they’ll push for additional investigations. They’re going to ask to get an MRI for their headache or an endoscopy for their abdominal pain. These procedures aren’t pleasant at all and as a doctor you don’t want your patients to go through that. They’re also not cheap and insurance may not cover them if they’re unwarranted. If you agree to your patient’s requests for investigations you may come off as shaky and unconfident. It’s probably better to stand your ground. You went to medical school and years of training while they didn’t. Maybe you can reach a common ground with them. Tell them to do as you say and if that doesn’t work you’ll start doing more investigations to find out what the problem is.

So you’ve stood your ground and you’ve convinced the patient of your diagnosis, or so you think, and you’ve agreed not to perform unnecessary investigations. Next comes the treatment. It’s important for a patient to believe in you and what you’re doing in order for them to be compliant to whatever it is you prescribed. If they still doubt you they won’t stick to the treatment regimen you want them to. This won’t be too bad if it’s an acute condition that’ll resolve in less than a week, but if it’s a little serious then treatment will be necessary and neglecting it can cause the condition to become worse. If that happens and patients come to you in a worse condition you can’t say “I told you so,” you’ll have to quickly fix the problem and despite that some patients may blame you for getting worse.

The worst outcome would be not just neglecting your treatment, but self medicating. So not only are they not getting better, but they’re also probably making themselves worse by taking unnecessary drugs that may exacerbate the condition they have. The damage of this will be limited by the fact that over the counter drugs aren’t that many in number and have limited side effects, but even something as insignificant as giving aspirin to a child with a viral infection can result in brain and liver damage. It’s important to explain to patients the importance of complying with treatment and the consequences of ignoring it. It’s also essential to explain what will happen if they choose to ignore your advice and treat themselves. This will all come down to your character as a doctor. Your patients need to see you as someone who’s confident, knowledgeable, and cares about them.

Online diagnoses will hurt your patients and your practice. It’s not great to have to convince most of your patients that what they read online is false. It can be frustrating that after all these years of training a patient may choose to believe what they find after a 5 minute search over you. They may also tell people that you don’t know what you’re doing if they refuse to believe you. That’s not something you can control or should worry about. As long as you don’t come off as shaky and unsure then your reputation should be intact. It’s important, however; to not be too aggressive or come off as callous no matter how stubborn a patient can be. At the end of the day you care about them and want what’s best for them. Remember that you’re the one who knows what’s best for them and you need to convince them of that with patience and care.